Implementation of Efficacy Enhancement Nursing Interventions With Cardiac Elders

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Introduction

Elderly citizens of the US often suffer from chronic conditions, the cardiovascular disease being one of them. At the same time, taking part in health-promoting activities combined with everyday medical management yields advantages for their health. Therefore, the development of highly effective nursing intervention procedures is important to improve their health.

Purpose

To test the implementation of efficacy enhancement nursing interventions, the aim of which is to improve the self-efficacy of patients to stimulate positive behavioral change.

Research hypothesis

Nursing interventions increase perceived self-efficacy in patients.

Review of the literature

The authors provide a review of the literature on the topic. The dates of publication range from 1977 to 2004; most of the materials come from the 1990s and 2000s. It is shown that according to the literature, patients with increased self-efficacy show better future health outcomes and higher quality of life. It is noted that literature, where efficacy-enhancing nursing interventions are developed and explained, is not abundant, hence the need for further research. The literature review also includes some materials on social cognitive theory.

Theory or theoretical framework used in the study

The social cognitive theory was employed as the basis for the study.

Study variables (experimental study only)

The study is not experimental.

Population

Patients of 5 academic hospitals in the states of California and Massachusetts.

Sample population

110 people (39 men and 71 women) of age 65 or older (mean age is 76.2, the standard deviation is 6.0) who were discharged from a hospital after a MI or a CABG were randomized from a larger group and studied for 12 weeks after being discharged. Due to the withdrawal from the study or death, 109 patients took part in the research after 6 weeks, and 106 patients were left after 12 weeks.

Participants

37% of participants were discharged after an MI, 63% – after a CABG. 90% of participants were Caucasian, 70% widowed, 79% lived alone, 18% lived with family and friends; 3% lived in other settings (e.g. assisted living).

Have the subjects’ rights been ensured? Confidentiality?

Yes. As some of the participants withdrew from the study, it is evident that they were informed about the study. None of the individual patients is mentioned.

Measurement tools

· It is stated that treatment fidelity was ensured. Validity and reliability of the utilized tools are not explicitly addressed, though it is mentioned that the instruments used “allowed for easy documentation and data entry”

Data collection method

All the interventions of the APNs who performed the study were recorded; for this purpose, an “investigator-developed data collection tool” was used (Hiltunen et al., 2005, p. 224). For all interventions, its type (phone call, a visit at home, rehabilitation facility, or a hospital) and the date, as well as intensity and longevity were recorded.

Data analysis

The gathered data were analyzed with descriptive statistics. The total frequency of contacts, as well as the frequency of the four planned interventions, were analyzed. The intensity of the APNs’ interventions was assessed as well.

Statistical procedures

Descriptive statistics were utilized. The frequency of contacts and intensity of interventions were analyzed.

Findings – significant to nursing?

Implications for nursing practice are suggested; utilization of nursing interventions to increase self-efficacy is recommended, and the recommended types of such interventions are offered. No implications for nursing education or research are mentioned explicitly.
Recommendations for further research are not made explicitly, although they might be apparent from the limitations of the study.

Limitations of the study

The study is limited by the dearth of assessment of the interventions by the subjects. It is highlighted that such information would have helped to learn which of the interventions were the most useful, and allow for easier refinement of the methods. Another restriction is the absence of analysis of such factors as sex, social and ethnic background, and cardiac diagnosis. The length of the interventions was also not recorded. Health outcomes also were not estimated.

Reference

Hiltunen, E. F., Winder, P. A., Rait, M. A., Buselli, E. F., Carrol, D. L., & Rankin, S. H. (2005). Implementation of efficacy enhancement nursing interventions with cardiac elders. Rehabilitation Nursing, 30(6), 221-229.

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